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Desperate patients seek relief at Toronto marijuana clinic

But critics say it's unethical for doctors to charge fee for prescription followup.

Dr. Ryan Yermus consults with Ruth, 72, who is battling crippling osteoarthritis. Yermus opened the first medical marijuna clinic in the city on Monday. (Richard Lautens / Toronto Star) | Order this photo

Dr. Danial Schecter is preparing to open the Cannabinoid Medical Clinic, at Yonge St. and Eglinton Ave. E., on July 14.
(Keith Beaty / Toronto Star) | Order this photo

On site at Medical Marijuana Clinics of Canada are CanvasRX representatives Johnathan Werynski (left) and Ronan Levy. They consult with patients to help them find the best distributor and strain of medical marijuana. (Richard Lautens / Toronto Star) | Order this photo

The door to the medical office opens slowly, and a woman steps into the cool interior.

The 72-year-old has a slight hunch in her back and knobby, swollen fingers. She’s come here, to Toronto’s first cannabis medical clinic, seeking relief from a constant ache — in her hands, feet and spine — wreaked by three decades of osteoarthritis.

“I can’t write. I can’t take a lid off a jar. And I can’t turn a door knob,” continued Ruth, who requested her surname not be published because she worries her landlord will frown upon her marijuana use.

Like Ruth, other patients on hand are eager for symptomatic relief and have come to get a prescription for medical marijuana. But because many physicians are reluctant to prescribe pot, some doctors are opening specialized cannabis clinics to meet the demand.

“The courts have already ruled that patients who want access to medical marijuana have the right to do so,” says family physician Dr. Ryan Yermus, who runs the Danforth Ave.

“I see our role at this clinic being to help those patients, who want to advocate for themselves and want to access medical marijuana, do so in a way that is responsible with proper medical supervision and proper medical followup.”

Under new rules introduced in April, medical marijuana patients no longer need a licence from the government, but they must now get pot prescriptions from a doctor or nurse practitioner. Patients can only buy weed from a licensed commercial grower. Health Canada expects that by 2024 more than 450,000 people will be using marijuana for medical reasons, generating $1.3 billion in annual sales.

The Canadian Medical Association (CMA), The College of Family Physicians of Canada and the Federation of Medical Regulatory Authorities of Canada are critical of the legislative changes. They argue there’s little scientific proof that marijuana is safe and medically beneficial.

“Physicians are going to have to tread very carefully because there’s a multi-billion-dollar industry out there that has product they have to move,” said Francescutti. “And, as of April, physicians are the barrier to moving that product.”

In an effort to monitor prescriptions, Health Canada recently proposed amending the regulations to require licensed producers to regularly report to medical and nursing licensing bodies, who exactly is prescribing pot, and in what quantities. (A public comment period about this ends July 13.)

At Yermus’s clinic, patients don’t require a referral but must provide documentation of the medical condition for which they want pot. He says qualifying conditions include HIV/AIDS, chronic pain, multiple sclerosis, seizure disorders, fibromyalgia and anxiety.

The medical consultation with Yermus is covered by OHIP but, if pot is prescribed, patients must pay a $200 annual fee for a “safety monitoring system.” That means his clinic will follow up with patients to ensure there are no side effects, and patients can contact doctors with questions.

Also on-hand at this clinic are advisers from CanvasRx, who help patients select a strain, pick a supplier, and fill out registration forms for the licensed producer. (CanvasRx says it’s not in partnership with any licensed producers and will present patients with all available options.)

On Monday, Ruth is one of the first patients to arrive — only a handful of appointments are booked for opening day. About a dozen people wander in seeking information, and bemused passersby point at the sign and peer into the clinic.

After two decades of popping 15 pills a day — tranquilizers and pain killers — Ruth wants an alternative. She weaned herself off those pills six months ago because she felt they weren’t working, worried about their addictive nature, and feared she would accidentally mix them up.

“When you’re taking that many pills, you don’t think straight,” says the senior, adding she could never get a proper night’s rest.

She started medicating with butter made from marijuana, purchased at a compassion club. A little dab on bread each evening gave her a good night’s sleep. But she never really knew exactly what she was consuming — once she ate a marijuana cookie and was sick for days.

She suspects her own doctor wouldn’t write a pot prescription, so she’s come to Yermus’s clinic. She’s hoping to be prescribed a strain that is low in THC, the psychoactive ingredient in marijuana.

“I’m not interested in getting high, I’m interested in sleeping.”

For Ruth, whose annual income is under $20,000, the clinic’s $200 fee is “a huge cost — it will take half my grocery money this month.” But, she adds, “I’m desperate.”

Many other patients are desperate, too. Family physician Dr. Danial Schecter, who will open the referral-only Cannabinoid Medical Clinic midmonth, says doctors are “waiting anxiously” for his clinic to open.

“Physicians are limited in terms of treating certain conditions,” explains Schecter. “And for those patients who have failed first or second-line therapies, and have seen several specialists, their primary care practitioners are looking for other ways of approaching these patients’ symptoms and getting them care that they need.”

For a fee, Schecter’s clinic will also offer ancillary services, such as advanced cannabinoid education and assistance in filling out forms for the licensed producer. Such services are optional and can be purchased individually or as a bundle for $200. (To help offset those costs Schecter is asking licensed producers to provide discounts on pot for his patients.)

Dr. Meldon Kahan, medical director of Substance Use Service at Women’s College Hospital says it is “unethical” for clinics to charge patients.

Prudent, he says, is about half a gram of marijuana per day — about one joint — containing less than 9 per cent THC. Especially concerning, says Kahan, is that some licensed producers are making strains with up to 30 per cent THC, which is much stronger than weed sold on the street.

At the end of her consultation with Yermus, Ruth emerges with a prescription for half a gram of marijuana per day — she intends to vaporize or mix it with honey. CanvasRx staff help her place an order with a licensed producer for 15 grams of marijuana, which should be delivered to her home by week’s end. (There’s no marijuana at the clinic itself.)

The marijuana costs about $150. She’ll have to cut back on her grocery bill this month, but a full night of rest is worth it.

“With marijuana, I wake up feeling like the day is worth living,” says Ruth.

Minutes later she heads home, hobbling along Danforth Ave., stopping to rest at every bench along the way.

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